A number of diseases and physical defects, the use of medication and certain life style choices may have a (pronounced) effect on your oral health. They may also limit your dental treatment, or necessitate certain precautionary measures. It is, therefore – in your interest – very important that we are fully aware of these facts and able to assess any potential risks. By completing the following questionnaire, based on the EMRRH-system (European Medical Risk Related History), you supply us with the necessary information. Your information will be treated with the utmost care and is covered by doctor-patient confidentiality.
Lay-out of the questionnaire
We will first ask certain details that are necessary for the administrative process, such as your name, address and your insurance details. Please make sure you have those details at hand. Subsequently, we will ask after your current state of health.
How much time will completing the questionnaire take?
The questionnaire contains 33 main questions. In case of a confirming answer, you will be asked for a clarification. You will only need to click on the relevant options. Completing the questionnaire usually takes about 15 minutes. By completing the questionnaire at home, at your leisure, your appointment will take 15 minutes less.